The effectiveness of psychological support interventions for those exposed to mass infectious disease outbreaks: a systematic review

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

A Rapid Access Brief Psychotherapy Intervention to Respond to Healthcare Workers in Ontario Whose Mental Health was Negatively Impacted During the COVID-19 Pandemic

OBJECTIVE

Although the coronavirus disease 2019 (COVID-19) pandemic has had widespread negative impacts on the mental health of healthcare workers (HCWs), there has been little research on psychological interventions during the pandemic for this population. The current study examines whether a brief coping-focused treatment intervention delivered in a virtual individual format would be associated with positive changes in Canadian HCWs' mental health during the pandemic.

METHOD

Three hundred and thirty-three HCWs receiving the intervention at 3 large specialty tertiary care hospitals in Ontario, Canada, completed measures of anxiety, depression, perceived stress, work/social impairment, insomnia and fear of COVID-19. After completing treatment, HCWs rated their satisfaction with the treatment.

RESULTS

The intervention was associated with large effect size improvements in anxiety, depression, perceived stress, insomnia and fear of COVID-19, and moderate effect size improvements in work/social impairment. At treatment session 1, prior mental health diagnosis and treatment were both significantly correlated with depression, anxiety, and work/social impairment scores. Secondary analyses of data from one of the sites revealed that treatment-related changes in anxiety, depression, perceived stress and work/social impairment were independent of age, gender, occupational setting, profession and the presence of a previous mental health diagnosis or treatment, with the exception that nurses improved at a slightly greater rate than other professions in terms of work/social impairment. HCWs were highly satisfied with the treatment.

CONCLUSIONS

A large number of HCWs experiencing significant distress at baseline self-referred for assistance. Timely and flexible access to a brief virtual coping-focused intervention was associated with improvements in symptoms and impairment, and treatment response was largely unrelated to demographic or professional characteristics. Short-term psychological interventions for HCWs during a pandemic may have a highly positive impact given their association with improvement in various aspects of HCWs' mental health improvement.

Interventions to build resilience and to ameliorate negative psychosocial effects of the COVID-19 pandemic on children and adolescents: a systematic review and meta-analysis

The psychosocial health of children and adolescents has been particularly affected by the COVID-19 pandemic. Containment measures have restricted social development, education and recreational activities, may have increased family conflicts and, in many cases, led to feelings of loneliness, sleep disturbances, symptoms of anxiety and depression. We conducted a systematic review to identify interventions that seek to ameliorate these detrimental effects of the COVID-19 pandemic and to build resilience in children and adolescents. Literature searches were conducted in the databases MEDLINE, EMBASE, PsycINFO, CENTRAL, WHO COVID-19 Global literature on coronavirus disease and Cochrane COVID-19 Study Register (up to 30 June 2022). The searches retrieved 9557 records of which we included 13 randomized-controlled trials (RCTs) for evidence synthesis. Included studies predominantly implemented online group sessions for school-aged children with either a psychological component, a physical activity component, or a combination of both. A meta-analysis of seven studies on anxiety and five on depressive symptoms provided evidence for a positive effect of interventions by reducing anxiety (Standardized Mean Difference (SMD) (95% CI): - 0.33 (- 0.59; - 0.06)) and depressive symptoms (SMD (95% CI): - 0.26 (- 0.36; - 0.16)) compared to the control interventions. Studies also showed improvements in positive mental health outcomes, such as resilience (n = 2) and mental and psychological wellbeing (n = 2). Exploratory subgroup analyses suggested a greater effectiveness of interventions that (i) are of higher frequency and duration, (ii) enable personal interaction (face-to-face or virtually), and (iii) include a physical activity component. Almost all studies were judged to be at high risk of bias and showed considerable heterogeneity. Further research may focus on the contribution of different intervention components or distinct subgroups and settings, and should examine children and adolescents over longer follow-up periods.

Prevalence and factors associated with general anxiety symptoms severity among older adults registered with the Primary Healthcare Corporation during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Primary care-based studies examining the prevalence of anxiety symptoms severity and associated factors among older adults during the COVID-19 pandemic are scarce. The study aims to determine the prevalence of general anxiety symptoms severity and associated sociodemographic and physical health characteristics, including SARS-CoV-2 infection history, among older adults in primary care in Qatar during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted using a random sample of older adults aged 60 years and above (n = 337) from all primary health care centers (n = 28) of Qatar's Primary Health Care Corporation. Participants were interviewed via telephone by family physicians between June and August 2020. General anxiety symptoms severity was assessed using the Generalized Anxiety Disorder 7-item Scale (GAD-7). Descriptive statistics and ordinal regression were used to analyse the data.

RESULTS

The mean age of participants was 65 years (ranging from 60 to 89 years), standard deviation = 4.8. About 49.0% and 32.0% of participants were females and of Qatari nationality, respectively. The prevalence of minimal, mild, moderate, and severe general anxiety symptoms was 82.5%, 13.9%, 3.0%, and 0.6%, respectively. Around 33.5%, 63.5%, and 3.0% of participants had unknown, negative, or positive SARS-CoV-2 infection histories, respectively. Females had greater odds of higher levels of anxiety symptoms severity (odds ratio (OR) 2.34; 95% confidence interval (CI) 1.22, 4.50; p = 0.011). As compared to participants with unknown SARS-CoV-2 infection status, those with a negative and positive SARS-CoV-2 infection history had increased odds of higher levels of general anxiety symptoms severity by 2.48 (95% CI 1.17, 5.24; p = 0.017) and 7.21 (95% CI 1.67, 31.25; p = 0.008), respectively. Age, marital status, living arrangements, nationality, and the number of medical conditions had no statistically significant associations with general anxiety symptoms severity.

CONCLUSIONS

Most older adults experience minimal to mild anxiety symptoms during the COVID-19 pandemic. Female gender and confirmed or suspected SARS-CoV-2 infection history are independent predictors of more severe anxiety symptoms among older adults.

The effectiveness of post-disaster psychotherapeutic interventions: A systematic review and meta-analysis study

OBJECTIVE

This study aimed to determine the level of impact of post-disaster psychotherapeutic interventions.

MATERIAL METHOD

For this systematic review and meta-analysis study, the studies were accessed through the databases of PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center in July-September 2022 without any year limitation. As a result of the examinations, 27 studies were included in the study. The data were synthesized by meta-analysis and narrative methods.

RESULTS

According to the results of this systematic review and meta-analysis, post-disaster psychotherapeutic interventions were found to be effective (SMD:-0838, %95 CI: -1,087- 0.588; Z = -6588, p = 0.000, I² = %95,249). Individuals who have undergone psychotherapeutic interventions experience either no or fewer post-traumatic stress disorder symptoms. The country/continent of the research, the types of psychotherapeutic interventions, the type of disaster, and the measurement tool used influence the effectiveness of the psychotherapeutic interventions. Psychotherapeutic interventions applied especially after earthquakes, one of the types of disasters, were found to be effective. In addition, EMDR, cognitive behavioral therapy, psychotherapy, and exposure method were found to reduce posttraumatic stress disorder symptoms in individuals in the post-disaster period.

CONCLUSION

Post-disaster psychotherapeutic interventions have positive impacts on people and improve their mental health.

Remote mental health care interventions during the COVID-19 pandemic: An umbrella review

Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.

Effectiveness and Cost-Effectiveness of Mental Health Interventions Delivered by Frontline Health Care Workers in Emergency Health Services: A Systematic Review and Meta-Analysis

This systematic review is to evaluate the effectiveness and cost-effectiveness of mental health interventions delivered by frontline health care workers in disasters and public health emergencies. Six databases and trial registries were searched, and manual searches were conducted. Of the 221 studies identified, 21 were included. Meta-analyses assessed differences between the intervention and control in terms of PTSD outcomes. Eleven studies of 1802 participants were incorporated in the meta-analysis. Interventions delivered or prompted by specialist health care workers showed significant and large effects in improving PTSD-related symptoms with a SMD = 0.99 (95% CI: 0.42-1.57, p = 0.0007). Interventions delivered or prompted by frontline non-specialist health care workers showed significant but small effects in improving PTSD-related symptoms with SMD of 0.25 (95% CI: 0.11-0.39; p = 0.0007). The results showed that most mental health interventions delivered by frontline health care workers effectively supported affected people. Mental health interventions delivered by mental health care professionals are effective in reducing PTSD-related disorders in natural disasters. Future adequately powered RCTs are needed to evaluate the effectiveness of mental health interventions delivered by trained non-specialists. Economic modelling may be useful to estimate cost effectiveness in low- and middle-income countries given the difficulties of conducting studies in disaster and emergency settings.

Pandemic Times and the Experience of Online EMDR Practice in Greece: A Qualitative Study on Obstacles and Perspectives

Covid-19 Pandemic has had a biopsychosocial impact on the Greek mental health system by worsening symptoms of depression and stress in the general population. As the need for mental health services increased, the Pandemic strongly affected EMDR practice, and training which was mainly online, during 2020. In a small sample consisting of 40 EMDR practitioners, a brief online questionnaire was administered concerning the obstacles that professionals believe they face doing online EMDR therapy in Greece during the Pandemic. A conventional qualitative analysis was conducted on the respondents’ feedback by coding the content. Among others, the results showed two categories of practical and psychosocial defects in the efficient application of online EMDR practice. Lack of physical contact, poor application of bilateral stimulation based on technical difficulties, poor computer skills, and physical exhaustion due to continuous lockdown were some of the content subcategories. The results are discussed concerning the current context of the Pandemic and local characteristics. Moreover, practical implications for online EMDR practice are discussed.